- posterior splint for 10 days in maximum equinus to reduce tension on the incision;
- cam walker w/ 15 deg of equinus (or gravity equinus), non wt bearing;
- pts are permitted non wt bearing ankle ROM exercises out of the cam walker;
- after approximately 3-4 weeks the leg is brought out of equinus to a neutral positoin;
- gradual wt bearing is allowed at 6 weeks;
- consider DVT prophylaxis for 6 weeks;
- Murphy's law:
- tell patients to be careful with shoe wear for the first 6 months post op, since the shoe counter (heel) can rub and abrade the incision (leading to secondary wound breakdown);
- in the report by Speck M, et al (1998), the authors report on their experience with early full wt bearing;
- evaluated the clinical outcomes of 20 pts w/ early full wt bearing and functional treatment after surgical repair of acute Achilles tendon rupture;
- patients underwent open repair using a Kessler-type suture and simple apposition sutures;
- postoperative regimen included a plantigrade splint for 24 hours and 6 weeks of early full wt bearing in a removable walker;
- at 1 day after surgery, early full wt bearing alternating with passive range of motion exercises was initiated;
- patients were instructed to move the ankle four times a day between 20° of plantar flexion and 10° of extension;
- there were no reruptures
- Early full weightbearing and functional treatment after surgical repair of acute achilles tendon rupture.
- references:
- Immobilization in neutral versus equinus position after Achilles tendon repair. A review of 32 patients.
- Early motion of the ankle after operative treatment of a rupture of the Achilles tendon. A prospective, randomized clinical and radiographic study.
- Elongation of the Achilles Tendon After Rupture Repair Occurred Slightly Less with Postoperative Early Motion Than with Postoperative Immobilization.
- Early Motion for Achilles Tendon Ruptures: Is Surgery Important? A Randomized, Prospective Study
- The Influence of Early Weight-Bearing Compared with Non-Weight-Bearing After Surgical Repair of the Achilles Tendon
- AAOS issues acute Achilles tendon rupture guidelines
- Effect of knee position on gap size following acute Achilles rupture